Evaluation Of The Safety And Efficacy Of Endoscopic Submucosal Dissection For Early Carcinoma Of The Upper Gastrointestinal Tract

Objective: To investigate the risk factors of postoperative complications of endoscopic submucosal dissection for early carcinoma of the upper gastrointestinal tract and the short-term and long-term effects.Methods: The clinical data of 174 patients with early esophageal squamous cell carcinoma and 121 patients with early gastric cancer who underwent ESD in the Department of Gastroenterology from Jan 1,2013 to Jan 31,2020 were retrospectively analyzed.According to whether post-ESD complications occurred,patients were grouped into groups to analyze the relationship between patients’ baseline characteristics,endoscopic treatment status,postoperative pathological results and other factors and post-ESD complications;the pathological results were used to evaluate whether curative resection was performed,and the prognosis was evaluated through long-term follow-up.Results: In 174 patients with early esophageal squamous cell carcinoma who received ESD,there were 19 cases of post-ESD stenosis(10.9%),4 cases of post-ESD perforation(2.3%),and 2 cases of post-ESD bleeding(1.1%).According to whether post-ESD stenosis occurred,patients were divided into post-ESD stenosis group(n=19)and post-ESD non-stenosis group(n=155).Logistic regression analysis showed that the depth of infiltration exceeded the lamina propria(OR=5.666,95%CI:1.011-35.216,p=0.043),the circumference of the lesion greater than 3/4(OR=31.757,95% CI: 5.259-191.767,p<0.001)are independent risk factors for post-ESD stenosis.The above-mentioned early esophageal squamous cell carcinoma patients with lesions greater than 1/2 were divided into oral hormone group(n=29)and control group(n=43)according to whether oral glucocorticoids were used to prevent stenosis.The incidence of stenosis in the two groups was significant the difference(p=0.046),the number of times of endoscopic esophagectomy needed to resolve the stenosis in the oral hormone group was significantly less than that of the control group(2.75±0.50 vs3.93±1.03,p=0.043).The postoperative complications of 121 patients with early gastric cancer undergoing ESD were 8 cases of post-ESD bleeding(6.6%)and 1 case of post-ESD perforation(0.8%).Patients were divided into post-ESD bleeding group(n=8)and post-ESD no bleeding group(n=113)according to whether post-ESD bleeding occurred.Logistic regression analysis showed that long-term use of antithrombotic drugs(OR=10.269,95%CI: 1.814-58.126,p=0.008)is an independent risk factor for bleeding after ESD.Efficacy: In 174 cases of early esophageal squamous cell carcinoma treated with ESD,the resection rate of whole block,complete resection rate and curable resection rate were 96.0%,89.1% and 87.4%,respectively.The five-year survival rate was 96.8% during the median follow-up period was 42 months with a total of 4 deaths,of which 3 were non-curable resection patients and 1 was curative resection patients.The en bloc resection rate,complete resection rate,and curative resection rate of 121 patients with early gastric cancer was97.5%,81.8%,and 73.6%,respectively.The five-year survival rate was 97.3% during the median follow-up period was 34 months with a total of 2 deaths,all of which were patients with non-curable resection.Conclusions: 1.Postoperative complications of ESD for early esophageal squamous cell carcinoma are mainly post-ESD stenosis.The depth of invasion exceeds the lamina propria,the circumference of the lesion greater than 3/4 are independent risk factors for stenosis after ESD.Oral glucocorticoids can reduce the occurrence of post-ESD stenosis and the number of times of endoscopic esophagectomy required to resolve the stenosis.2.The postoperative complications of ESD treatment of early gastric cancer are mainly post-ESD bleeding.Long-term use of antithrombotic drugs is an independent risk factor for post-ESD bleeding.3.ESD for early carcinoma of the upper gastrointestinal tract has a definite curative effect and a good prognosis.After the operation,close endoscopic follow-up should be carried out regularly in order to find recurrence and metachronous cancer in time and improve supplementary treatment.For patients with non-curative resection,follow-up treatment plans should be customized based on postoperative pathological results and basic conditions.